Holding on to the past…or a finger in the dike?

The world of health care today is much different than the one I became involved in as a physician over 35 years ago. But why should that surprise me? The world in general is so dramatically changed from that which I knew then, it would seem reasonable and totally understandable that we’ve had to make dramatic changes in how we work with the population in maintaining health. Or have we? For it seems to me that in many cases the volume-based, paternalistic, top down, cottage industry approach which served us generations ago still has a strong presence, at least intellectually and emotionally, in many in the medical profession.

It is true there are rumblings across the landscape of medicine, which bear strange and ominous acronyms—PCMH, HCH, ACO—which would bespeak of a need for fundamental changes in how we in the health care system interrelate with our patients and with each other. I mean, we’ve got computers, emails, Internet, smart phones, iPads, Second Life, to name a few of the technological advances which have changed the world in which we live.

So isn’t it strange and a bit disconcerting that many of us in health care hold on to a love affair with paper records, stored lovingly in extensive medical record departments, unavailable to all but a few “chosen” among us who can access that information. Heaven forbid we consider how much of a benefit it would be if the information stored in those vaults was available to our patients, others within the health care system, and other caregivers who touch the lives of those we see.

While the world around us embraces new technology, sometimes perhaps too rapidly, we still are debating the value of electronic health records. I continue to see articles defending the value of a paper record, challenging the benefit of an electronic record. They speak of privacy issues, excessive cost, extended work efforts, disruption of the physician/patient encounter. But all around us we see fundamental changes in processes in finance, purchasing, banking, managing legal affairs, which are changing the fabric of our society.

It’s time to recognize that while there are major issues to be addressed by the explosion of the new technologies, we must begin to move into that world, embrace the complexity, let go of our long-held values and beliefs which are barriers, and begin to engage actively in understanding how we may use that technology to improve our ability to engage what is becoming an increasingly “wired” public.

It’s a bit like that poor Dutch boy, who continued to try to hold back the impending torrent of water behind that proverbial dike. We’re going to run out of virtual fingers of resistance, and be overwhelmed and perhaps drowned by the torrent of information coming at us. With Meaningful Use criteria, as imperfect as they might be, staring us in the face, we must begin to think creatively about the asynchronous relationships available through the new technology, as options to the synchronous relationships cherished by many of use old enough to remember the days of Marcus Welby.

Perhaps as some say, it’s not a better world, but it’s a new world, and we can’t put the cork back in the bottle in an effort to restore a vintage with which we’re often more comfortable. I’m constantly surprised when I speak and ask an audience of health care professionals—“How many of you are actively considering how to use smart phones and iPads in designing your health care home/medical home?”—to see a smattering of hands, and a shrugging of shoulders. If we don’t begin to address the technologies available to us in our redesign, we’re just “putting new wheels on a horse and buggy” and increasing the chasm between what our citizens expect and what they are getting from health care reform.

Basic, fundamental, not in need of restating, but at least I feel better. Of course, I’m not sure why but thanks for listening. Now back to my disruption of the status quo.